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Tuesday, October 4, 2011

Who's The Boss? Midwife or Obstetrician?

Oh my - I sit here shaking my head with disbelief at what I am reading - have maternity wards in the U.K. gone totally backward into the 19th Century? To a time when the midwife was queen of the birthing process, and men were to be banned at all costs?

"The NHS Institute for Innovation and Improvement’s guidance for midwives, for instance, instructs them to ‘focus on normal birth and reduce the Caesarean rate’. Doctors, it says, should ‘only enter the room of a labouring woman when asked to review (the patient) by a midwife’."

Excuse my ignorance, but I would have thought that the obstetrician had precedence over the midwife in any decisions about whether a Caesarean or other intervention is required? And why should a doctor NOT check on a patient during labour, midwife or not? I am quietly stunned by this attitude, as the obstetrician surely has far, far more training than a midwife?

"And despite objections from obstetricians, the RCM’s high-profile Campaign For Normal Birth has the slogan: ‘Intervention and Caesarean shouldn’t be the first choice — they should be the last.’ "

Perhaps because I am not a medical person, I really can't understand why the different professions are fighting each other - surely to goodness the one thing they should all agree on is that the outcome of the labour is a healthy baby and a healthy mother? No matter what intervention is required, and Caesarean or not.

Now I imagine we would all agree that the vast majority of midwives do a sterling job, but we all know stories of those who did far less than sterling jobs, and stories of ones who were outright overbearing, rude and dismissive of their pregnant or labouring patients.

"Gill Edwards, a leading clinical negligence solicitor with the firm Pannone, is in no doubt why these fatal mistakes continue. ‘Too often, we see a desire for autonomy, sometimes verging on arrogance, on the part of some midwives,’ she says. ‘It leads them to ignore National Midwifery Council rules that require them to call on the skills of other health professionals whenever something happens which is outside their sphere of practice.’ "

Perhaps this is what is going on at Furness General Hospital in Cumbria, where police actually launched an investigation into the deaths of five babies and two mothers, and where another baby's death is also going to be investigated?

The U.K. statistics for stillbirths show an average of 11 per day, through NHS hospitals. You would believe this was a third world country. And everyone seems to point the finger at everyone else - but the general consensus is that midwives need to integrate with the obstetricians and gynaecologists, that the safe delivery of the baby is the goal when all is said and done.You would hope and pray that the government is prevailed upon to allocate better funding for midwifery training, and the NHS as a whole. It appears, from the article in the "Mail Online" that midwives are not receiving training they require, and the RCM

"warned last week that cuts in training budgets mean that for many midwives, training has to be self funded and largely online."

This is surely rather like learning to cook in a virtual kitchen? And the maternity staffing shortages have been going on for more than four years. Meanwhile, until these issues have been addressed and dealt with, parents are advised to:

"Ask the right questions, says solicitor Gill Edwards.

‘So many maternity hospitals sell themselves by pointing to low rates of intervention or Caesarean sections, with the emphasis on the peace and quiet or the number of birthing pools. But the real test is the number of healthy births at the unit.’ "